Infectious diseases in South Asia - time to work with our neighbours

India has lost ground against some of the most difficult diseases, such as tuberculosis (TB), and has seen the continued rise of vector-borne diseases, such as dengue. By Prof. Ramanan Laxminarayan, Director and Senior Fellow at the Center for Disease Dynamics, Economics & Policy (CDDEP)&Dr Buddha Basnyat , Medical Director at Oxford University Clinical Research Until-Nepal

With the annual dengue and chikungunya season upon us, India’s poor preparedness for even anticipated infectious disease threats is in the spotlight once again. Much ink and television news channel time will be spent on passing blame on who is responsible for the continuing high burden of these two diseases. Our challenge in fighting even the annually unwelcome visitors, lays bare our lack of readiness for the infectious diseases that lurk in the background, waiting to emerge (avian influenza) or re-emerge (drug resistant varieties of current infectious diseases). India has lost ground against some of the most difficult diseases, such as tuberculosis (TB), and has seen the continued rise of vector-borne diseases, such as dengue. Today, infectious diseases account for more than one-quarter of the country’s disease burden.

Our neighbors in the sub-continent share these challenges. Infectious diseases do not carry passports and do not care for visa restrictions that prevent Indians from going to Pakistan and vice versa. We may choose not to talk to our neighbours but we share their diseases. The greatest threat to gains in polio eradication in India come from Pakistan. By the same token, India’s policies that allow antibiotics to be mixed with poultry feed have consequences for public health in Nepal, which imports all of its feed from India.

With rapid globalization, outbreaks in one country can travel the globe within days. Take for example, the SARS (severe acute respiratory syndrome) outbreak, which originated in China in 2003 and spread to 30 countries across Asia, the Americas and Europe, with a death toll in the thousands during the first year of the outbreak. The economic losses in Asia topped $10 billion USD. The more recent H1N1 influenza outbreak in India in 2009, despite attempts at control, spread quickly throughout the country and the region, testing the national and regional capacity to prevent and contain pandemic scale outbreaks.

The countries of India, Nepal, Sri Lanka, Pakistan and Bangladesh are home to a quarter of the world’s population. They have similar climatic, socio-economic and demographic characteristics and are all faced with high infectious disease burden. In addition to the longstanding endemic diseases, newer threats like Zika and Ebola may continue to arise. Is the region prepared to take preventive measures and to control outbreaks once they start? A recent review of preparedness, does not show significant progress. The capacity to both detect and control outbreaks is rated poor.

The established endemic diseases, particularly malaria, TB and HIV, are becoming increasingly resistant to first-line drugs around the world, adding to the disease burden and increasing the cost of treatment. India is among the highest burden countries for multi-drug resistant TB. In Nepal, Pakistan and Bangladesh, antibiotic misuse is common whilst people in remote areas have scant access. The result is both accelerating antibiotic resistance and deaths from untreated infections, respectively. According to the WHO, more than 60 percent of patients in developing countries are not treated according to standard treatment guidelines that embody rational drug use. India and Nepal, in fact, have also seen a re-emergence of many infections, namely cholera, typhoid, measles, diphtheria, chikungunya, and Japanese encephalitis. A lack of accurate rapid diagnostic tests is yet another problem. For example, in post-earthquake Nepal, an outbreak of scrub typhus was widely mis-diagnosed as typhoid, and due to incorrect diagnosis and treatment, many succumbed to their illness. This was despite readily available and inexpensive antibiotics that would have cured them.

Urgent investments in public health systems, regulation and surveillance for early detection, with inexpensive but accurate diagnostics, and rapid response, are the need of the hour. Immediate measures include developing and sharing scientific know-how for prevention and control between countries and implementing behavior change interventions and national policies. Nothing supports the case better than the paradigm of the emergence of the dengue epidemic. It may be surprising to many that dengue was only a sporadic infection in the 1960s within the region. It became an epidemic disease in India and Sri Lanka in the early 1990s, Bangladesh in 2000, Pakistan in 2006, Nepal in 2010 and Bhutan in 2013. A lack of surveillance and containment measures has allowed the disease to take deep roots in the region. If action is not taken, other diseases will doubtless follow in dengue’s footsteps.

We must talk to our neighbours. Unless we address infectious diseases together, we are putting millions of lives at stake.

Subscribe to our Newsletters

Consumption of food contaminated with Salmonella can cause salmonellosis, one of the most common bacterial food-borne illnesses. The most common symptoms of salmonellosis are diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating the contaminated product.

According to the research published in the journal 'Cancer Prevention Research', the most significant reduction in risk occurred in the first 10 years after quitting, with a modest but continued decline in later years.